Texas State nursing students experience Nicaraguan hospitality

By Alicia Vazquez

When the St. David’s School of Nursing students from Texas State University signed up for two weeks of volunteer service at a third world country, they knew it wouldn’t be the same as providing healthcare in the United States.

What was not completely expected was that the experience would require them to use skills from their first days of nursing school and provide an opportunity to immerse themselves in the culture through the Nicaraguan people.

Stepping out of the comfort zone

Elizabeth Biggan, clinical assistant professor at St. David’s School of Nursing, said she prepares the students by talking to them about the poverty that they’ll see. She also shows them videos from previous trips, but she can’t fully prepare them for the clinics.

“Every bit of school that they go through at home is in a hospital where all equipment is readily available. All medications are readily available,” Biggan said. “It’s hard on the students to have a patient who needs medication, but they don’t have it and they have no way to get it. They really have to learn to adapt to the situation, but they also learn to get creative with their solutions.”

Nursing student Anastasia Houze listens to a baby's heart during the Campuzano community clinic. Photo by Alicia Vazquez
Nursing student Anastasia Houze listens to a baby’s heart during the Campuzano community clinic. Photo by Alicia Vazquez

Experiencing those situations is what makes students’ nursing skills grow. In the Nicaragua clinics, they can’t rely on machines for reassurance.

Students manually check vital signs like blood pressure and temperature, something most haven’t done for four semesters. Biggan said this is where students step out of their comfort zones and learn to trust themselves.

The language barrier

The nursing students ranged from feeling confident with Spanish, to remembering some words from Spanish class in high school, to not knowing any Spanish at all. Some prepared for the clinics by studying the anatomical terms in Spanish. Others had to learn on the spot or rely on the translators, but the difficulty was part of the volunteering experience.

A young patient and nursing student Bridgette Young exchange smiles before beginning the health assessment.
A young patient and nursing student Bridgette Young exchange smiles before beginning the health assessment. Photo by Alicia Vazquez

“The first house visit was mostly people looking at me and at one point even laughing, like ‘what is this girl saying?,’” said nursing student Bridgette Young. “By the end they were really understanding me and actually answering back without the translator.”

Massiel Acetuno, assistant team leader, said it’s difficult for the students to have social conversations when they’re not able to fully express themselves in the foreign language.

The students used their broken Spanish, hand gestures, facial expressions and voice pitch as they tried to make connections with the people.

“Volunteers try to do signs or play with the kids to bond with them,” Acetuno said. “Sometimes I feel helpless when I see them struggling with language but I like to see that even though they’re not speaking the same language, it’s like their souls connect.”

When people of different cultures meet

Acetuno, who is constantly introducing new people to her culture, said she enjoys it because it’s her chance to tell people why she’s so proud of being Nicaraguan. Acetuno describes Nicaraguans as people who welcome visitors and who receive them as family members.

“I love the most when we go to house visits and clinic days and they’re able to see by themselves that I wasn’t lying, that everything I said was true,” Acetuno said. “People still welcome you even though their houses are really poor, they always say to you ‘come in’ without any fear, without any doubt.”

The house visits to the communities are the first opportunity that the nursing students get to interact with Nicaraguans.

“They’re going to give you all the chairs for you to sit down. These people are so nice, so selfless,” nursing student Jessica Ramirez said. “They don’t have a lot to offer but they still keep offering.”

A baby boy stands in his crib at the Campuzano community. Photo by Alicia Vazquez
A baby boy stands in his crib at the Campuzano community. Photo by Alicia Vazquez

International Service Learning, the organization that plans the volunteering trips, identifies rural areas where healthcare is not easily available. This means that the conditions will be some that the students may not have seen before.

There were latrines, houses with dirt floors and without doors, wood cribs and unpaved roads. Despite the conditions, Nicaraguans displayed something else to their visitors.

“Happiness. They only show how grateful they are for the things that they have,” Acetuno said. “You may not see in their faces pain or sadness. You may not see depression, but most of the people that we see in the communities have huge problems. Sometimes they don’t have anything to eat that day.”

On the final day at the communities, the students handed out rice and beans, played games with the children and broke a piñata. It was a day to forget about nursing work and interact with the community they had been helping.

“I think the most difficult thing was giving the families rice and beans,” Ramirez said. “When we handed the parents food, that was real. We were giving them a means to survive for a week.”

Acetuno said that at the end of the trip it’s not just about helping people but also about taking the time to understand their situation, understand their history and why they are the way they are.

For nursing student Rachel Nading, leaving Nicaragua was the most difficult thing.

“I feel like it’s not enough. I feel like I could do more,” Nading said. “More in medical care, in treating people, just more.”

A girl waves goodbye at the nursing students after they finish conducting the health census at her home. Photo by Alicia Vazquez
A girl waves goodbye at the nursing students after they finish conducting the health census at her home. Photo by Alicia Vazquez

Dr. Camilo Gutierrez teaches American nursing students in Nicaragua

International Service Learning in Nicaragua takes English-speaking doctors and pairs them with student nurses from America that go to Nicaragua to set up clinics in poor communities.

Dr. Camilo Gutierrez, 32, is one of the doctors. Born in Masatepe, Nicaragua and is a general practice doctor that works with ISL two to four times a year.

In January, he went into rural communities with nursing students from the St. David’s Nursing School at Texas State to treat patients and teach the students about medical care in Nicaragua.

Just like Dad

Dr. Gutierrez discusses potential diagnosis with nursing student, Bridgette Young.

When Gutierrez was young, his father was a gynecologist in Nicaragua. Gutierrez would always play with his dad’s stethoscopes and echoscopes that he brought home from work.

During high school, he realized his fascination with his father’s work and decided to begin his path to becoming a general practice doctor.

Throughout his career, he has had the chance to do great things with his medical talent. In 2011, he began working with ISL in Nicaragua and in 2015 he was a medic on Discovery Channel’s Naked and Afraid.

Gutierrez said that the experience was fun but working with the poor communities is what he enjoys doing to make him a better doctor.

“What helps me become a better doctor is to help people who really need it,” Gutierrez said. “It helps spiritually because it satisfies me helping people with what I have chosen to do with my life.”

Serving the Underserved

Dr. Gutierrez examines a patient with a potential throat infection.

With the Texas State nursing students Dr. Gutierrez went to two communities. Both were rural, impoverished communities where most people had little-to-no education and no medical insurance.

The patients in those communities were grateful to have seven days of vitamins and ibuprofen.

Gutierrez heard about ISL when his mother was selling medicine to ISL back in 2011. When she asked why they ordered medicine in bulk, she told them her son was a doctor that spoke English.

Now Gutierrez is able to practice medicine in the places that keep him motivated as a doctor. When Gutierrez works with International Service Learning, he also gets to give a better quality medical attention in the rural clinic setting.

“A quality medical attention is at least 15 minutes. In my own clinic, I spend half an hour with any patient,” Gutierrez said. “At the hospital, we are told only to spend 10 minutes on a patient because we can see as many as 70 patients a day.”

However, working in the clinics, the students and the doctors are able to spend enough time with the patient to go through every step of an assessment.

 Teaching American Nurses

IMG_2413 (1).jpg
Dr. Gutierrez working on a patient assent with student, Michelle Wali.

The Texas State nursing students who spent two weeks learning from Gutierrez were responsive to his method of teaching.

Gutierrez interacted and laughed with the students when they weren’t seeing patients. This helped the relationship when assessing patients because the students weren’t afraid to ask questions about their diagnostic opinion.

Emily Estes was one of the students who learned from Gutierrez in the clinic setting during her time in Nicaragua.

“In the states, many doctors are passive and will dismiss you,” Estes said. “Here, I never have to feel bad about asking the doctors questions.”

Michelle Wali, a nursing student who is always asking questions and eager to learn, was astounded by how in-depth the teaching moments were with the doctors.

“All of the doctors here are asking me how I feel and how I am doing in the assessment,” Wali said. “They steer me in the right direction, which is really showing of how it’s a different relationship between doctors and nurses here.”

Wali and Estes both said there can be a lack of communication between doctors and nurses in the hospitals in the states.

Gutierrez said he thought it was absolutely ridiculous that those frontiers were up in the states.

“Doctors and nurses are a team,” he said. “I learn from the nurse at my private clinic just as much as she learns from me, and after five years together we have learned a lot.”

The Only Way to be Immortal

Gutierrez works with teams when the chief of International Service Learning in Nicaragua calls him anywhere from two to four times a year.

“I like the way American students show interest on the job,” Gutierrez said. “Most of the Americans want to learn new things and how to examine the patients.”

Gutierrez’s passion to teach medicine to students comes from the same place where he found his passion to be a doctor: his father.

“In the words of my father ‘the only way to be immortal is sharing what you know,’” Gutierrez said. “ ‘Any person who is listening to the things you explain will have a part of you, so you will live in their brains with what you taught them.’ ”



Meet One of the Doctors Helping Nursing Students Grow in Nicaragua

By: Elisha Colip

Dr. Quezada helps nursing student Sarah Lohmeyer with a patient assessment. Photo by: Elisha Colip

During the St. David’s School of Nursing at Texas State students trip to Nicaragua in January, they had the opportunity to work with multiple doctor
s and translators from Nicaragua. Dr. Melina
Quezada was one of those doctors.

While Quezada has a history of working with patients of all ages, she now works at a pathology lab doing cancer diagnosis. She’s also beginning to work at some of the clinics held by the International Service Learning organization in Nicaragua.

“I wanted to start being a doctor because I always wanted to help people,” she said. “I like kids and there is so many poor people here and I would like to help them. That’s the main reason I started medicine.”

Quezada was born in Jinotepe, Nicaragua about an hour south of Managua where she lives now with her family.

She began her medical journey in 2002 at a public university in Managua, Universidad Nacional Autónoma de Nicaragua or  National Autonomous University of Nicaragua. She studied medicine for five years, and then she practiced for three years in a residency-like position.

Quezada then worked a year on her own before going back to study her specialty.

According to the World Bank, Nicaragua is the second poorest country in Latin America. According to the World Food Programme, almost half the country lives on less than $1 a day and three-fourths of the country lives on less than $2 a day.

More than 40 percent of the population in Nicaragua is unemployed according to the United Nations Development Programme: Human Development Reports. The Texas State nursing students go every year to help the communities.

“Forty percent of the population of Nicaragua is employed so what happens when the students come is you create jobs for the driver of the bus, the owner of the hotel, the lady who cooks the food, the restaurants, the translators and the doctors,” said Jario Rivas, ISL coordinator. “It is a big help for the country.”

Dr. Quezada addresses the group of nursing students on the first day of clinics. Photo by: Elisha Colip

Quezada works for the Ministry of Health in Nicaragua, which provides public health services for most of the population. The problem lies when the population doesn’t have transportation or the means to obtain transportation for health care.

After working with patients for awhile, Quezada moved to pathology where she runs cancer diagnosis tests for women, mostly cervical and vaginal cancers.

The tests must be very accurate in order to get a proper reading. When doing a pathology report, the doctor usually performs a biopsy on the cells that look cancerous. The doctors then run tests on the cells and compare them to normal cells to diagnose what kind of tumor or cancer it is and the stage it is in.

“Sometimes people don’t take the test very well and tests can be messed up,” Quezada said. “It is necessary for it to be accurate to make a real diagnostic of cancer. Sometimes people just take it and lay it on the table.”

Being the person to say whether or not someone has cancer can be a hard job. Quezada said how people handle the news really just depends on them as a person. She says her aunt had cancer last year and was always happy, never sad.

“I think that people with cancer know what they have and they know that they will die, but they begin to find peace with themselves,” Quezada said. “For the family it is bad. I just think that in the end the patient is happy.”

One of Quezada’s hardest experiences as a doctor was during her first year of practice. She had just moved to a new place and was starting her new job all alone.

“I had a baby who died,” Quezada said. “It was so sad. The pregnant mom had a problem and we didn’t have an emergency surgery so the baby died inside. I was lonely and sad and had been crying, but then at 2a.m. a 35-year-old pregnant woman came in. The most beautiful thing was she was pregnant with twin babies. I didn’t know what to do, but the doctor told me, ‘You can do it!’ The first baby was born head first and then the other feet first. It wasn’t death and it was so beautiful.”

How she got the job with ISL actually ties back to Texas.

An old classmate of Quezada, Dr. Orlando Renner was one of the doctors who previously worked with the Texas State nursing students. When Renner moved to the Austin area he told Quezada she had to apply and work with ISL.

Dr. Quezada helps nursing students asses a urinalysis. Photo by: Elisha Colip

“She is wonderful, I love her,” said Elizabeth Biggan, assistant clinical professor at St. David’s School of Nursing at Texas State. “I totally trust her skills, but I love that even if students are not totally correct with what they think is going on, she’s so supportive says, ‘Maybe it could be that, but what about this?’ and gives them a little bit more information to let them process. That is where that AH-HAH moment light goes on and she facilitates that.”

This is the first year Quezada has worked with the nursing students from Texas State.

“This is my first time with her, but she is awesome,” said Rivas. “She likes kids, she likes to work with babies. I admire her. Today I told her ‘ Dr. Quezada, you are one of the best doctors that I have met at this organization. I hope to work with you in the future.’ She is amazing.”

When Quezada is not working to help the people of Nicaragua, she is spending time with her two five-year-old twins, Viola and Monica.

“I think the worst part is you can’t always be with your family,” Quezada said. “I have twin babies and they are most special to me.”

Dr. Quezada is pictured in the floral scrubs with the group of students on the last day of the clinic.


Hotel Cooks in Nicaragua share their truth

Hotel el Raizon is a Nicaraguan hotel located in between the cities of Masaya and Nindiri that specializes in group housing. The owner prides herself on the feeling of home that visitors feel. Although her immediate family lives in the hotel, the true family feel comes from the staff.

I was saddened to know that the joyous relationship I believed I felt was not present amongst the staff and the owner. To the kitchen staff, it was merely a job. I felt a hesitation when speaking with them. The translator looked to me and said, “She is scared she is going to get in trouble.”

Paula Mejia, age 56, and Yahel Ortiz, age 32, both walk from their homes each morning to the hotel before dawn and often leave after nightfall. Their duties are not only confined to the kitchen, but also maintenance of the lobby area. They begin their day preparing the food for breakfast. The kitchen staff consists on 4 women who cook and serve. The daily menus are chosen in advance by the owner. The staff sometimes serves several large groups at once time, often preparing different meals for each.

Mejia began working for Hotel el Raizon over 10 years ago. Meija first worked there for five and a half years. She ran into difficulty when trying to leave and find another job. When she returned to the owner in search for a letter of recommendation, she was instead offered her position back at the hotel. Since then, she has remained at the hotel for another five years.

Ortiz has been employed with the hotel for a year. Her sister first worked there, and when the hotel hosted a group too large, Ortiz joined them for assistance. She has since worked at the hotel as a cook. Her biggest upset working at the hotel is that she often gets home late and is not able to spend much time with her two daughters.

Over the two weeks the students were able to experience many meals key to the Nica culture. Some of these include the gallo pinto, nacatamal and quesillo. The students were also able to take a tortilla-making class led by the cooks of the hotel.

When asked what was most special about working at the hotel, Mejia had this to say, “I feel comfortable when some foreigners come and treat me like a person, like I exist. They talk to me and treat me with good manners. They don’t complain about the food; they are thankful and treat me well.”

Nursing Student and Patient Time Lapse in Nicaragua

Every year St. David’s School of Nursing at Texas State University goes to Nicaragua. They work with the International Service Learning organization to host free clinics in communities that do not have access all the time to medical care. In this video, nursing student Jennifer Trevino worked with an elder patient at a clinic in Las Lomas, Nicaragua.

Video By: Elisha Colip
Music: Home by Phillip Phillips

The Innocence of Childhood

My time in Nicaragua would not have been the experience it was without the many children I was privileged to meet. Although the language barrier was hard to overcome, we managed to have an understanding of love that was easy to comprehend.

It was amazing to me how something like a game of tag or soccer could be so universal and bridge so many gaps. The second day of the clinic I had my iPad with me. When we grew tired after several games of tag, I remembered the apps I had on my iPad. From drawing to matching games, we were able to play and communicate past my broken Spanish.

There is a certain beauty in the innocence of children. I have always loved working with kids. I have an admiration for how free they are; that is a feeling that I would like to be able to carry with me into my adulthood.

When one of the children asked one us about a past visitor they had in their community, my heart was heavy. I can’t even express the feeling. I was hurt. It hurt me to think about the fact that a few years from now to many of us this will have been a resume-building experience and we will have moved on with our every-day lives. However in a few years in their lives, they very well will still remember us by name. So many little moments in life that we tend to take for granted are key moments in another’s.

I met a young boy, Nelson, who dreams of being an artist. The drawing app on my iPad was amazing to him. He was so proud to show me the many things he was able to recreate. They had a sense of pride in everything they were able to share with us.

I befriended 11-year-old Danna Jael on the first day in the community of Campuzano. She noticed my interest in the animals in the community and began to show me more. She stayed with me thought home visits that day, and visited our clinics each day we were there.

When it was Danna’s turn to use my iPad, she began drawings of me. I was touched by what she ended up creating. It was eye opening to see what she saw in me. One thing remained consistent: in each picture, there was a smile. She then looked to me and asked, “nombre complete” asking for my full name. When I looked down to my iPad to write my name, the many pictures she had drawn overwhelmed my spirit with a feeling that I will never forget. “Maria y Danna amigas por siempre: Mary and Danna friends forever.”

I know that the days I spent in the community with these kids will leave an impact of them and be a memory they never forget. I can only hope to carry the spirit and love from the kids with me in my future.

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” –Maya Angelou

An immersive study abroad program in the School of Journalism & Mass Communication